Hi Lactnetters,

This is my first time posting to this informative list. First of all, I
agree with the discussion so far that epidurals risk interrupting what
might have turned out to be an otherwise uneventful labor.  As a former L&D
nurse at a large tertiary care teaching hospital, I have also taken care of
enough laboring women with epidurals to see a pattern (mom gets epidural,
labor slows down, pit augmentation ensues, pain increases, epidural is
redosed, mom can't feel to push, vacuum-assisted delivery or other
operative delivery follows).  Though it doesn't always turn out that way,
it happens quite a bit.  If we believe epidurals also affect early
breastfeeding and there isn't a lot of research on the topic, some nurses
in a position to do research should do it!  IBCLCs in cooperation with
maternal care nurses would be the perfect investigators, I think.

I have two children, both of whom were delivered by midwives, the first in
a birth center and the second in a hospital.  I didn't have an IV or pain
medication/epidural, or any other intervention either time.  If I have a
third baby (approaching 40 years) I intend to have a home birth, with the
absolute support of my husband.  My husband is an anesthesiologist.  You
guys, not all anesthesiologists want laboring women to have epidurals.  My
husband tells me he would be just as happy if he didn't have to do any!
They really aren't big money-makers compared to other types of cases.
Unless an anesthesiologist does only OB work, there doesn't seem to be any
real incentive to "sell" epidurals.  Also, based on my experience as an L&D
nurse, many women *want* epidurals.  They come in asking for them.  And
there are also L&D nurses who try and get their patients to get epidurals
because it makes their patients more manageable.  I really believe that the
key to helping women take more control of their labors and deliveries is in
the prenatal education.  Lacking that, we can be proactive and try and use
other comfort measures to support our laboring patients.  But if they beg
and plead for the epidural, eventually someone will give it to them.

L Rutledge, RN, MSN

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